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The Use of Mobile Apps to Increase Physical Activity Level: A Systematic Review

Dziyana Nazaruk*, Kelli Rouser

Health Policy and Community Health, Georgia Southern University, Savannah, USA

Abstract: Background: About 82% of the U.S. adult population owns a smartphone. More than half of that population downloaded a fitness or health app to increase the physical activity level. The current review included studies that have utilized mobile apps in conjunction with other intervention strategies to increase physical activity levels. Methods: The search was conducted in five electronic databases. Studies were included if they were randomized controlled trials, utilized mobile apps, physical activity was the primary outcome, written in English, and conducted between the years of 2007 and 2019. Results: Thirteen studies were included in the final review. Results indicated that multi-component interventions reported significant improvements in physical activity across all age groups. The most substantial behavior change effects were observed in interventions that combined apps with health coaching, individualized text messages, and self-monitoring component. The overall results indicated that 8 out of 13 included studies reported statistically significant improvement in physical activity level with mobile app utilization in multi-component interventions. Conclusion: This review suggests that mobile apps have the potential to effectively deliver physical activity interventions, by providing tailored-based approach, unlimited accessibility, and monitoring. Therefore, future studies must focus on the effective delivery of evidence-based physical activity interventions through mobile apps in various populations.

Keywords: physical activity, mobile apps, smartphone, exercise

Received April 20, 2021; Revised May 25, 2021; Accepted June 03, 2021

Citation: Dziyana Nazaruk, Kelli Rouser, The Use of Mobile Apps to Increase Physical Activity Level: A Systematic Review. Journal of Physical Activity Research, 6 (1). 36-47. January 2021. doi:10.12691/jpar-6-1-6

1. Introduction

Regular physical activity has been proven to result in a lower risk of mortality from all causes [1]; however, very few adults meet the recommendations for physical activity. Globally, low level of physical activity is responsible for numerous health and economic burdens. It has been estimated that 7% of type 2 diabetes, 6% of heart disease, 10% of colon cancer, and 10% of breast cancer can be attributed to physical inactivity. Overall, physical inactivity is accountable for 9% of all premature mortality [2]. The prevention of these non-communicable diseases is an essential goal for the public health community worldwide. Given the numerous benefits of physical activity [3], there is a need to design interventions that can cost-effectively reach a large population. In addition, utilizing various motivation techniques [4], offering realistic goal-setting [5], providing regular feedback [6], and using primary care setting as one of the outlets to promote health-related behaviors [7,8,9] can result in a sustainable increase in physical activity.

Mobile phones are a quintessential part of people’s lives and have become hubs for a rapidly evolving digital lifestyle [10]. According to previous research, 82% of the U.S. adult population owned an app-enabled mobile phone [11]. More than half of this population of users have downloaded a fitness or health app that assist in monitoring, recording, and tracking progress to exercise adherence [12]. With the number of users steadily on the rise, the field of mobile health provides the opportunity to increase disease prevention and management using mobile technology [1]. The use of apps in health promotion and disease prevention has enabled researchers to apply health behavior techniques that have proven to facilitate change among a large population [13].

Multiple factors can affect one’s health, such as diet and other lifestyle behaviors. Therefore, the efficacy of the mobile phones utilization to improve health through the increase of physical activity level remains unclear. Previous systematic reviews have aimed to synthesize evidence for efficiency; however, they included additional factors that could influence behavior change, such as diet and sedentary behaviors. One systematic review attempted to evaluate the potential effectiveness of mobile-phone-based approaches to promote physical activity however the emphasis was put on the use of the technology in its entirety including SMS messaging, e-mail, and websites [14]. To our knowledge, no systematic review to date has focused primarily on the usability of mobile apps to increase the physical activity level. The objective of this study was to address the gaps in the literature by presenting evidence of the use and efficacy of mobile apps to increase the physical activity.

2. Methods

A comprehensive search of five electronic databases including PubMed, PsychINFO, CINAHL, Science Direct, and Web of Science was conducted from March through June 2019. A keyword search was performed using the following search string: (Mobile apps OR app OR smartphone) AND (Physical activity OR Fitness OR Exercise).

2.1. Inclusion and Exclusion Criteria

To be considered for this review, studies were required to analyze randomized controlled trials that utilized mobile apps for physical activity as the primary outcome between the years of 2007 and 2019. International studies were also eligible for inclusion but had to be written in English. Studies that did not examine a control group and those where physical activity was not reported were excluded. Finally, studies were also excluded if pre-existing conditions were a factor.

2.2. Data Extraction

The database search after duplicates were removed yielded 2020 potentially relevant articles. From those articles, a screening of the abstract was conducted, and 1,880 articles were excluded. Of the remaining 140 articles, the full text was assessed, and 122 of those were excluded from the study because they were not randomized controlled trials. The remaining 13 studies that analyzed randomized controlled trials that assessed an adult population and adolescent populations were included in the final review (Figure 1). Data extraction was conducted using a standard procedure developed for this study (Table 1), and similar to the one used in other systematic review [14]. The information from each study was extracted based on source, study design and duration, intervention components, outcomes measures, and results.

Table 1. Characteristics of the mobile apps-based interventions included in the review

Figure 1. Flowchart of study selection process (From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. doi: 10.1136/bmj.n71)

3. Results

A total of 13 randomized controlled trials were included in this review [15,16,17,18,19,20,21,22,23,24,25,26,27]. Four studies were conducted in North America [19,21,25,26], four in Europe [16,17,24,27], four studies were conducted in Australia and New Zealand [15,18,20,21], and one study in the Middle East [22]. Two studies targeted adolescents [15,27], and the remaining eleven focused on adults [16,17,18,19,20,21,22,23,24,25,26]. The duration of the interventions ranged from one to six months [15,16,17,18,19,20,21,22,23,24,25,26,27]. The primarily targeted health behavior was physical activity. The secondary targeted health behaviors were dietary intake and weight status. Some studies also included additional outcome measures such as body mass index (BMI), blood pressure, and heart rate. Ten out of thirteen studies utilized multi-component interventions which included strategies such as health coaching, counseling sessions, individual feedback via text messages, and also the use of digital-physical activity tracking devices such as “Fitbits” and pedometers [16,17,18,20,22,23,24,25,26,27]. Six studies reported interventions that utilized a theoretical component such as Social Cognitive Theory, Transtheoretical Model, and Control Systems Theory of self-regulation, Self Determination Theory, Theory of Planned Behavior, the I-Change Model, and the Fun theory [18,20,23,24,25,27].

Interventions delivered solely via an app all showed an increase in physical activity, but there were only significant changes noticed in one study [19]. All the multi-component interventions showed improvements in physical activity level [16,17,18,20,22,23,24,25,26,27]; however, five out of ten did not find statistical significance between comparison and control group [17,18,20,25,27].

Only two studies targeted children or adolescents [15,27]. Out of the two, the study that utilized stand-alone approach did not find a statistically significant difference in the fitness level between the intervention and control groups [15]. The multi-component intervention based on the social network support was also unable to find a statistically significant difference between the intervention and control groups. However, it could be explained by the limited availability of the research material because the intervention only lasted one week [27].

3.1. Theory Utilization

Of the six studies that utilized the theoretical component, only two showed statistically significant changes [23,24]. Quinonez and colleagues used theoretical methods from the I-Change Model. The intervention utilized the following theoretical methods: consciousness-raising and feedback on performance, action planning, preparatory planning, and coping planning, and reinforcement. Results indicated that participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after six months than participants in the control group [23]. Partridge et al. utilized the Transtheoretical Model of Behavior Change. Messages were matched to stage-of-change for each of the individual lifestyle behaviors. Researchers found that adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg lighter than control, consumed more vegetables, fewer sugary soft drinks, and fewer energy-dense takeout meals compared to controls. Most importantly, the intervention group increased their total physical activity by 252.5 MET-minutes and overall physical activity by 1.3 days compared to controls [24].

4. Discussion

In this review, only three studies used stand-alone interventions where the mobile app was the only component [15,19,21]. The remaining studies used apps in conjunction with other intervention strategies [16,17,18,20,22,23,24,25,26,27]. It was observed that multi-component interventions reported significant improvements in physical activity across all age groups. This indicates that multi-component interventions may yield stronger intervention effects. The most substantial behavior change effects were observed in interventions that combined apps with health coaching or individualized text messages [16,20,23,25]. Although the integration of apps in multi-component interventions likely produce substantial increases in physical activity; future testing is needed.

This study also indicated that physical activity interventions that included a self-monitoring component were able to generate a substantial increase in physical activity [16,18,20,26], which is consistent with previous research [28]. These apps can alert people to their levels of inactivity and motivate them to make subtle changes to increase physical activity.

Most of the app interventions in this review targeted adults [16,17,18,19,20,21,22,23,24,25,26] with only two targeting children and adolescents [15,27]. Because technology and mobile devices are such an integral part of adolescents’ lives; it is imperative that future studies are conducted that focus on children.

Overall, eight out the 13 studies reported significant improvements in physical activity [16,19,21,22,23,24,25,26,27]. The findings from this review indicate that mobile apps can be a useful tool in promoting physical activity and other healthy behaviors. There are many advantages to utilizing smartphone apps over different intervention strategies such as counseling and health coaching. They can quickly provide access to intervention programs by offering self-monitoring, feedback, and social support.

Lastly, since the primary care setting is a useful outlet for education and the promotion of physical activity [7,8,29,30,31], it could be utilized to prescribe evidence-based smartphone apps interventions to various populations. However, this topic should be investigated further.

4.1. Strengths and Limitations

Strengths of this systematic review included a comprehensive search strategy that ensured the accuracy of the reviewed data. Another advantage is the scope of this review was limited to app interventions that targeted physical activity as the primary outcome. Lastly, this review only included randomized control trials.

One of the weaknesses of this review was the variation in terms of sample size, intervention components, and duration of the studies. However, the overall conclusion was that a large sample size, multiple intervention components, and longer period of the intervention would have a more significant impact on the level of physical activity.

5. Conclusion

Considering the fact that 82% of the U.S. adult population owned an app-enabled mobile phone [11], and more than half of this population utilizes fitness or health app [12], this review provides the support that mobile apps can be an effective channel in promotion and maintenance of the physical activity which is consistent with previous studies [32,33]. However, the success of the mobile app intervention will be primarily based on the quality of the intervention design. Besides, this review suggests that multi-component interventions appear to have a more significant effect than stand-alone interventions. Therefore, future studies should examine the efficacy of multi-component interventions that combine multiple intervention strategies, including theory utilization.

In conclusion, this review suggests that mobile apps have the potential to effectively deliver physical activity interventions, by providing tailored-based approach, unlimited accessibility, and monitoring. Therefore, future studies must focus on the effective delivery of evidence-based physical activity interventions through mobile apps in various populations.

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